Sampson F C, Goodacre S W, O'Cathain A
Health Services Research, ScHARR, University of Sheffield, Sheffield, UK.
ScHARR, University of Sheffield, Sheffield, UK.
Emerg Med J. 2014 Oct;31(e1):e9-e18. doi: 10.1136/emermed-2013-203079. Epub 2014 Mar 20.
Pain management in emergency departments (ED) is often inadequate despite the availability of effective analgesia, with many patients receiving insufficient and untimely analgesia. We conducted a systematic literature review to identify interventions that could improve pain management in the ED.
We systematically searched seven databases for studies reporting pain management outcomes after intervention to change professional practice to improve pain management in the ED, compared with pain management before or without intervention. Data was synthesised using principles of narrative synthesis.
We identified 43 relevant studies, including 40 uncontrolled before-and-after studies. Interventions included implementation of guidelines and protocols, educational interventions, pain scoring tools and changes in nursing roles, with many multifaceted interventions incorporating two or more of these elements. Interventions aimed to improve assessment and documentation of pain, knowledge and awareness of pain management and reduce time to analgesia. Due to the high probability of bias in study design and significant variation between studies, it was not possible to estimate the overall effectiveness of interventions, or identify which had the greatest impact. Intervention to improve pain management was reported to have some positive impact in most studies, but these findings may be explained by limitations in study design.
Many interventions reported improvements in pain management, but current evidence is insufficient to recommend any for widespread adoption. In order to improve pain management we need to understand more about the theory underlying interventions, the context in which interventions work, and develop interventions based on this stronger theoretical understanding.
尽管有有效的镇痛方法，但急诊科的疼痛管理往往不足，许多患者得不到充分和及时的镇痛治疗。我们进行了一项系统的文献综述，以确定可以改善急诊科疼痛管理的干预措施。
我们系统地检索了七个数据库，寻找报告干预措施后疼痛管理结果的研究，这些干预措施旨在改变专业实践以改善急诊科的疼痛管理，并与干预前或无干预情况下的疼痛管理进行比较。数据采用叙述性综合原则进行综合分析。
我们确定了43项相关研究，其中包括40项非对照的前后对照研究。干预措施包括实施指南和协议、教育干预、疼痛评分工具以及护理角色的改变，许多多方面的干预措施包含了上述两个或更多要素。干预措施旨在改善疼痛的评估和记录、疼痛管理的知识和意识，并减少镇痛时间。由于研究设计中存在较高的偏倚可能性，且研究之间存在显著差异，因此无法估计干预措施的总体有效性，也无法确定哪些干预措施影响最大。在大多数研究中，改善疼痛管理的干预措施被报告有一些积极影响，但这些发现可能可以用研究设计的局限性来解释。
许多干预措施报告了疼痛管理方面的改善，但目前的证据不足以推荐任何一项措施广泛采用。为了改善疼痛管理，我们需要更多地了解干预措施背后的理论、干预措施起作用的背景，并基于这种更强的理论理解来开发干预措施。
